129 results on '"Zulu, Joseph Mumba"'
Search Results
102. Acceptability of an economic support component to reduce early pregnancy and school dropout in Zambia: a qualitative case study
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Banda, Emmanuel, primary, Svanemyr, Joar, additional, Sandøy, Ingvild Fossgard, additional, Goicolea, Isabel, additional, and Zulu, Joseph Mumba, additional
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- 2019
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103. Acceptability of the human papillomavirus vaccine in schools in Lusaka in Zambia: Role of community and formal health system factors.
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Kucheba, Fortress, Mweemba, Oliver, Matenga, Tulani Francis L., and Zulu, Joseph Mumba
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ATTITUDE (Psychology) ,COMMUNITY health services ,IMMUNIZATION ,INTERPROFESSIONAL relations ,SPIRITUALITY ,STUDENT health ,VACCINATION ,WOMEN'S health ,HUMAN papillomavirus vaccines ,QUALITATIVE research ,COMMUNITY support ,JUDGMENT sampling ,HEALTH literacy - Abstract
Zambia has one of the highest cervical cancer rates in the world. This paper explores the acceptability of the Human Papillomavirus vaccine administered in girls (9–13 years) in Zambia. A qualitative case study was conducted in two schools in Lusaka district, which participated in the pilot for the Human Papillomavirus vaccine rollout. The study revealed that community level health systems factors such as knowledge levels about the vaccine, sexual morality concerns, conflicting views from parents on the vaccine, rumours that the vaccine contained cervical cancer and that it causes infertility in girls, previous bad experience with other vaccines, religious beliefs such as belief that God protects against illness, the nature of the school environment as well as faith in doctors shaped the uptake of the vaccine. Furthermore, formal health system factors such as availability of health workers and nature of collaboration between the Ministries of Health and Education influenced acceptability of the vaccine among the girls. Strengthening collaboration between community and formal health systems can play a vital role in supporting uptake of vaccines at community level as factors that hinder uptake of the vaccines emanate from both the community and health sector. [ABSTRACT FROM AUTHOR]
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- 2021
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104. Dismantling historical power inequality through authentic health research collaboration: Southern partners' aspirations.
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Matenga, Tulani Francis L., Zulu, Joseph Mumba, Corbin, J. Hope, and Mweemba, Oliver
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ATTITUDE (Psychology) , *GOAL (Psychology) , *HEALTH services accessibility , *HEALTH status indicators , *INTERPROFESSIONAL relations , *INTERVIEWING , *RESEARCH methodology , *MEDICAL care research , *MEDICAL personnel , *POWER (Social sciences) , *RESPONSIBILITY , *QUALITATIVE research , *JUDGMENT sampling , *DATA analysis software - Abstract
Several health research organisations whose work focuses on international collaboration outline guidelines that support ethical practice in health research partnerships including building consensus around good collaborative research practice. This paper explores researcher's perspectives, experiences, and reflections on the elements of successful health research partnerships between Northern and Southern countries/institutions. The study adopted a qualitative research approach using in-depth interviews to explore what an authentic partnership is as experienced and aspired by stakeholders in health research partnerships in Zambia. Interviews were conducted with stakeholders implementing various health research activities in the country. Our findings revealed that Southern partners aspired for equal status and participation, transparency, and accountability, interdependency, and reciprocity, commitment to shared goals, open dialogue and sustainability in partnerships. While to some extent these aspirations overlap with the categories covered throughout the different partnership guidelines, some key aspects go beyond what is included in existing recommendations such as status and recognition which are salient in the broader guidelines. An important aspect in dismantling power structures that causes inequality in partnerships is through generating knowledge and innovation using local resources in the South to address local needs which can be subsequently re-used to address challenges at the global level. [ABSTRACT FROM AUTHOR]
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- 2021
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105. Hope and despair 3/3: pluses and minuses for community health assistants in rural Zambia
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Zulu, Joseph Mumba, primary, Michelo, Charles, additional, Kinsman, John, additional, Hurtig, Anna-Karin, additional, and Zulu, Joseph Mumba, additional
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- 2016
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106. A systematic review of factors that shape implementation of mass drug administration for lymphatic filariasis in sub-Saharan Africa
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Silumbwe, Adam, primary, Zulu, Joseph Mumba, additional, Halwindi, Hikabasa, additional, Jacobs, Choolwe, additional, Zgambo, Jessy, additional, Dambe, Rosalia, additional, Chola, Mumbi, additional, Chongwe, Gershom, additional, and Michelo, Charles, additional
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- 2017
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107. Responding to non-communicable diseases in Zambia: a policy analysis
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Mukanu, Mulenga M., primary, Zulu, Joseph Mumba, additional, Mweemba, Chrispin, additional, and Mutale, Wilbroad, additional
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- 2017
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108. 1/3. Hope and despair: the community health assistant role in Zambia
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Zulu, Joseph Mumba, primary, Michelo, Charles, additional, Kinsman, John, additional, Hurtig, Anna-Karin, additional, and Zulu, Joseph Mumba, additional
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- 2015
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109. Hope and despair 2/3: what motivates Zambian community health assistants
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Zulu, Joseph Mumba, primary, Michelo, Charles, additional, Kinsman, John, additional, and Hurtig, Anna-Karin, additional
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- 2015
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110. Introduction of male circumcision for HIV prevention in Uganda: analysis of the policy process
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Odoch, Walter Denis, primary, Kabali, Kenneth, additional, Ankunda, Racheal, additional, Zulu, Joseph Mumba, additional, and Tetui, Moses, additional
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- 2015
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111. Innovation in health service delivery: integrating community health assistants into the health system at district level in Zambia
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Zulu, Joseph Mumba, primary, Hurtig, Anna-Karin, additional, Kinsman, John, additional, and Michelo, Charles, additional
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- 2015
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112. Improving Validity of Informed Consent for Biomedical Research in Zambia Using a Laboratory Exposure Intervention
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Zulu, Joseph Mumba, primary, Lisulo, Mpala Mwanza, additional, Besa, Ellen, additional, Kaonga, Patrick, additional, Chisenga, Caroline C., additional, Chomba, Mumba, additional, Simuyandi, Michelo, additional, Banda, Rosemary, additional, and Kelly, Paul, additional
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- 2014
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113. Integrating national community-based health worker programmes into health systems: a systematic review identifying lessons learned from low-and middle-income countries
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Zulu, Joseph Mumba, primary, Kinsman, John, additional, Michelo, Charles, additional, and Hurtig, Anna-Karin, additional
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- 2014
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114. Hope and despair: community health assistants’ experiences of working in a rural district in Zambia
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Zulu, Joseph Mumba, primary, Kinsman, John, additional, Michelo, Charles, additional, and Hurtig, Anna-Karin, additional
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- 2014
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115. Developing the national community health assistant strategy in Zambia: a policy analysis
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Zulu, Joseph Mumba, primary, Kinsman, John, additional, Michelo, Charles, additional, and Hurtig, Anna-Karin, additional
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- 2013
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116. HIV, syphilis and sexual-risk behaviours' prevalence among in-and out-of-school adolescent girls and young women in Zambia: A cross-sectional survey study.
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Musonda, Patrick, Halwiindi, Hikabasa, Kaonga, Patrick, Ngoma-Hazemba, Alice, Simpungwe, Matildah, Mweemba, Mable, Tembo, Chowa, Zyambo, Cosmas, Chisoso, John, Munakampe, Margaret, Choonga, Powell, Ngalamika, Owen, Musukuma, Mwiche, Chavula, Malizgani P., Sichula, Noah, Mweemba, Oliver, Zulu, Joseph Mumba, and Phiri, Henry
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TEENAGE girls , *HIV , *YOUNG women , *YOUNG adults , *GENDER-based violence , *SYPHILIS - Abstract
Background: In Zambia, 3.8% of young women and men aged 15–24 are HIV positive. However, like in most developing nations, HIV prevalence is higher among young women than young men (5.6% versus 1.8%). Despite the recognition of the rights of young people to sexual reproductive health (SRH) information and services, adolescent and young people (AYP) still face challenges in accessing healthcare in public health institutions including access to comprehensive knowledge on HIV/AIDs, HIV testing and contraceptives. The overall objective of the study was to collect baseline HIV, SRH and gender based violence (GBV) data at district level to inform the design of interventions targeting adolescent girls and young women (AGYW) aged 10–24 years in 20 districts of Zambia. Methods: A cross-sectional, mixed-methods study was conducted in 20 districts of Zambia with the highest incidence of HIV. Data was collected between August and October 2022 with a total response rate of 92% (12,813/13960), constituting 5979 (46.7%) in-school and 6834 (53.3%) out-of-school participants. Results: Overall, Mwinilunga, Chinsali, Chisamba and Chembe districts had the highest number of respondents, while Sinazongwe and Mungwi districts contributed the least. The overall age distribution was such that 12.6% (n = 1617) of those interviewed were aged 10 to 14 years, 35.4% (n = 4536) were aged 15–19 years, and 52.0% (n = 6660) were aged 20–24 years. The overall mean age at first sex among AGYW interviewed was 16.6 years which was broken down as follows: 16.2 years for in-school and 16.8 years for out of school. Overall, most of the respondents had first time sex with either their boyfriend (80.4%) or husband (15.6%), with 2.4% of the in-school participants reporting to have had their sexual debut in marriage compared to 21.0% among out-of-school AGYW. Prevalence of HIV was higher in the out-of-school compared to the in-school participants (5.5% vs 2.0%), Similarly, the prevalence of syphilis was higher in the out-of-school than the in-school participants (4.1% vs 1.5%). Conclusion: The study focused on assessing the prevalence and vulnerability of HIV, syphilis, GBV, and SRH services uptake among adolescent girls and young women, and exploring factors affecting girls' stay-in-school and re-engagement. The study found that HIV and syphilis are still significant public health problems among adolescent girls and young women in Zambia, emphasizing the need for increased efforts to prevent and manage these infections. [ABSTRACT FROM AUTHOR]
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- 2024
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117. Integration of systematic screening for tuberculosis in outpatient departments of urban primary healthcare facilities in Zambia: a case study of Kitwe district.
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Zulu, Davy Wadula, Silumbwe, Adam, Maritim, Patricia, and Zulu, Joseph Mumba
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Background: Tuberculosis (TB) is the leading cause of death from a single infectious agent globally, killing about 1.5 million people annually, yet 3 million cases are missed every year. The World Health Organization recommends systematic screening of suspected active TB patients among those visiting the healthcare facilities. While many countries have scaled-up systematic screening of TB, there has been limited assessment of the extent of its integration into the health system. This study sought to explore factors that shape the integration of systematic screening of TB in outpatient departments of primary healthcare facilities in Kitwe district, Zambia. Methods: This was a qualitative case study with health providers including district managers, TB focal point persons and laboratory personnel working in six purposively selected primary healthcare facilities. Data was collected through key informant (n = 8) and in-depth (n = 15) interviews. Data analysis was conducted using QDA Miner software and guided by Atun's Integration framework. Results: The facilitators to integration of systematic screening for TB into out patient departments of primary health facilities included the perceived high burden TB, compatibility of the systematic screening for TB program with healthcare workers training and working schedules, stakeholder knowledge of each others interest and values, regular performance management and integrated outreach of TB screening services. Constraining factors to integration of systematic screening for TB into outpatient departments included complexity of screening for TB in children, unbalanced incentivization mechanisms, ownership and legitimacy of the TB screening program, negative health worker attitudes, social cultural misconceptions of TB and societal stigma as well as the COVID-19 pandemic. Conclusion: Systematic screening of TB is not fully integrated into the primary healthcare facilities in Zambia to capture all those suspected with active TB that make contact with the health system. Finding the missing TB cases will, therefore, require contextual adaptation of the systematic screening for TB program to local needs and capacities as well as strengthening the health system. [ABSTRACT FROM AUTHOR]
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- 2022
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118. Community and health provider perspectives on the quality of family planning and contraceptive services in Kabwe District, Zambia.
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Nkole, Theresa, Silumbwe, Adam, Munakampe, Margarate N., Cordero, Joanna Paula, Milford, Cecilia, Zulu, Joseph Mumba, and Steyn, Petrus S.
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FAMILY planning , *MEDICAL quality control , *CONTRACEPTION , *FOCUS groups , *DISCUSSION , *COUNSELING , *PATIENT participation , *ATTITUDE (Psychology) , *STAKEHOLDER analysis , *MEDICAL personnel , *COMMUNITIES , *PATIENT satisfaction , *MEDICAL care costs , *MEDICAL care use , *QUALITATIVE research , *SEX distribution , *INTERPERSONAL relations , *THEMATIC analysis , *JUDGMENT sampling , *CONTENT analysis , *DATA analysis software - Abstract
Quality family planning and contraceptive (FP/C) services result in positive outcomes such as client satisfaction and sustained use of contraceptives. While most assessments of quality in FP/C services are based on measurable reproductive health outcomes, there is limited consideration of the perspectives and experiences of health providers and community members. This study aimed to address this knowledge gap, by exploring health providers' and community perspectives on the elements of quality FP/C services in Kabwe district, Zambia. Fourteen focus group discussions and 10 in-depth interviews were conducted in October–December 2016, involving community members, key community stakeholders such as religious and political leaders, health committee members and frontline and managerial healthcare providers. Data were analysed using a thematic approach. According to study participants, quality FP/C services would include provision by skilled personnel with positive attitudes towards clients, availability of preferred methods and affordable products. Additional factors included appropriate infrastructure, especially counselling services spaces and adequate consultation time. Participants stressed the need for reduced waiting time and opportunity for self-expression. The efficiency and effectiveness of service delivery factors, such as information dissemination and community engagement, were also considered important elements of quality FP/C. This study underscores the value of considering both community and health provider perspectives in efforts to improve the quality of FP/C services, with the overall aim of increasing client satisfaction and sustained utilisation. However, service delivery processes must also be addressed in addition to providing for community participation, if quality is to be achieved in FP/C services. [ABSTRACT FROM AUTHOR]
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- 2021
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119. Effects of economic support, comprehensive sexuality education and community dialogue on sexual behaviour: Findings from a cluster-RCT among adolescent girls in rural Zambia.
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Hegdahl, Hanne Keyser, Musonda, Patrick, Svanemyr, Joar, Zulu, Joseph Mumba, Grønvik, Taran, Jacobs, Choolwe, and Sandøy, Ingvild Fossgard
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CONTRACEPTION , *RISK-taking behavior , *MIDDLE schools , *HUMAN sexuality , *MIDDLE school students , *SEX education , *RANDOMIZED controlled trials , *COMPARATIVE studies , *TEENAGERS' conduct of life , *HEALTH attitudes , *DESCRIPTIVE statistics , *ENDOWMENTS , *STATISTICAL sampling , *WOMEN'S health , *RURAL population , *EDUCATIONAL outcomes - Abstract
Adolescent girls in Sub-Saharan Africa are at high risk of poor sexual and reproductive health outcomes. We present findings from a cluster-randomised trial in rural Zambia on the effects of economic support, comprehensive sexuality education (CSE) and community dialogue on sexual activity, contraceptive use and beliefs among adolescent girls. We recruited 157 schools in 2016, and all girls in grade 7 were invited to participate. Schools were randomised to either economic support, combined economic support, CSE and community dialogue, or control. Economic support consisted of unconditional cash transfers to girls and their guardians, and payment of school fees for girls continuing to grades eight and nine. CSE and community dialogue meetings focused on practices around girls' fertility, marriage and education. The interventions lasted two years from 2016 to 2018, with follow-up for another two years. The effects on outcomes were measured in 2018 and 2019 and compared using generalised estimating equations. We found that economic support lowered sexual activity (risk ratio (RR) 0.70; 95% C.I. 0.54 to 0.91), with a small added benefit of CSE and community dialogue. Economic support and the additional CSE and community dialogue were effective in lowering unprotected sexual activity (RR 0.53 for combined support vs. control; 95% C.I. 0.37 to 0.75). There was no evidence of intervention effects on contraceptive use among those ever sexually active, but the addition of CSE and community dialogue improved contraceptive use among those recently sexually active (RR 1.26; 95% C.I. 1.06 to 1.50) and knowledge regarding contraceptives (RR 1.18; 95% C.I. 1.01 to 1.38) compared to economic support alone. Perceived community support regarding contraceptives was lower in both intervention arms compared to the control. These findings indicate that economic support in combination with CSE and community dialogue can improve the sexual and reproductive health of adolescent girls. • Three-arm cluster-RCT conducted among adolescent girls in rural Zambia. • Economic support intervention: cash transfers and school fees. • Combined intervention: economic support, youth clubs and community dialogue. • Both economic and combined interventions reduced sexual activity. • Combined intervention increased contraceptive use and knowledge. [ABSTRACT FROM AUTHOR]
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- 2022
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120. "The ones at the bottom of the food chain": structural drivers of unintended pregnancy and unsafe abortion amongst adolescent girls in Zambia.
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Zulu JM, Crankshaw TL, Ouedraogo R, Juma K, and Aantjes CJ
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Background: Access to safe abortion care is highly unequal and fundamentally rooted in socioeconomic inequalities which are amplified by restrictive social norms and legal systems. We analyse these inequalities along the reproductive health continuum amongst adolescent girls in Zambia., Methodology: This paper draws from 20 focus group discussions conducted in 2021 with community members (young/adult) in five urban, peri urban, and rural sites in Zambia. Data was analysed using thematic analysis., Results: Adolescent pregnancy in the community was reported to be very common across the communities with girls from poorer families being disproportionately affected. Parents were reported to be complicit in facilitating their daughter's sexual-economic exchanges which emerged as a key driver of pregnancies. Young age and unmarried status meant adolescent girls could face triple stigma: stigma around accessing contraception to prevent a pregnancy, stigma in experiencing an unintended pregnancy and stigma around terminating an unintended pregnancy. There were clear socioeconomic differences in adolescent girl's exposure to community and health provider censure and/or acceptance of their pregnancy, and in their ability to conceal an abortion. Having the means to pay for health care allows some adolescents to seek terminations earlier and to access private health facilities while poorer adolescent girls face greater exposure to community censure through their embeddedness within the community. Abortions in this group attracts greater visibility through complications arising from their constrained choice for safe abortion methods. Stigmatising attitudes of community members also undermined adolescents' reproductive agency and mental health. For adolescents who choose to keep an unintended pregnancy, reintegration into school was highly challenging despite a national policy in place, with marriage being viewed as the only future option for poorer teenage mothers., Conclusion: The embeddedness of adolescent pregnancies within community structures of economic insecurity and gendered and age-related power relations highlight the importance of introducing community level approaches to tackle unintended pregnancies and unsafe abortion. Understanding teenage pregnancy as a community issue creates opportunities for community level support to young girls especially when they return to school., (© 2024. The Author(s).)
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- 2024
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121. Halting and re-issuing of the Zambia community health strategy (2017-2021): a retrospective analysis of the policy process and implications for community health systems.
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Chavula MP, Silumbwe A, Munakampe MN, Zulu JM, Zulu W, Michelo C, and Mulubwa C
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- Zambia, Humans, Retrospective Studies, Policy Making, Universal Health Insurance, Community Health Services organization & administration, Stakeholder Participation, Interviews as Topic, Health Policy, Qualitative Research
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Background: Over the years, low-and middle-income countries have adopted several policy initiatives to strengthen community health systems as means to attain Universal Health Coverage (UHC). In this regard, Zambia passed a Community Health Strategy in 2017 that was later halted in 2019. This paper explores the processes that led to the halting and re-issuing of this strategy with the view of drawing lessons to inform the development of such strategies in Zambia and other similar settings., Methods: We employed a qualitative case study comprising 20 semi-structured interviews with key stakeholders who had participated in either the development, halting, or re-issuing of the two strategies, respectively. These stakeholders represented the Ministry of Health, cooperating partners and other non-government organizations. Inductive thematic analysis approach was used for analysis., Results: The major reasons for halting and re-issuing the community health strategy included the need to realign it with the national development framework such as the 7th National Development Plan, lack of policy ownership, political influence, and the need to streamline the coordination of community health interventions. The policy process inadequately addressed the key tenets of community health systems such as complexity, adaptation, resilience and engagement of community actors resulting in shortcomings in the policy content. Furthermore, the short implementation period, lack of dedicated staff, and inadequate engagement of stakeholders from other sectors threatened the sustainability of the re-issued strategy., Conclusion: This study underscores the complexity of community health systems and highlights the challenges these complexities pose to health policymaking efforts. Countries that embark on health policymaking for community health systems must reflect on issues such as persistent fragmentation, which threaten the policy development process. It is crucial to ensure that these complexities are considered within similar policy engagement processes., (© 2024. The Author(s).)
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- 2024
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122. Collaboration for implementation of decentralisation policy of multi drug-resistant tuberculosis services in Zambia.
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Chavula MP, Matenga TFL, Maritim P, Munakampe MN, Habib B, Liusha N, Banda J, Sinyangwe NN, Halwiindi H, Mweemba C, Mubanga A, Kaonga P, Chewe M, Phiri H, and Zulu JM
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- Humans, Zambia, Politics, Stakeholder Participation, Health Services Accessibility organization & administration, Delivery of Health Care organization & administration, Cooperative Behavior, Community Health Workers organization & administration, Female, Male, Tuberculosis, Multidrug-Resistant drug therapy, Health Policy, Qualitative Research, Health Personnel
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Background: Multi-drug-resistant tuberculosis (MDR-TB) infections are a public health concern. Since 2017, the Ministry of Health (MoH) in Zambia, in collaboration with its partners, has been implementing decentralised MDR-TB services to address the limited community access to treatment. This study sought to explore the role of collaboration in the implementation of decentralised multi drug-resistant tuberculosis services in Zambia., Methods: A qualitative case study design was conducted in selected provinces in Zambia using in-depth and key informant interviews as data collection methods. We conducted a total of 112 interviews involving 18 healthcare workers, 17 community health workers, 32 patients and 21 caregivers in healthcare facilities located in 10 selected districts. Additionally, 24 key informant interviews were conducted with healthcare workers managers at facility, district, provincial, and national-levels. Thematic analysis was employed guided by the Integrative Framework for Collaborative Governance., Findings: The principled engagement was shaped by the global health agenda/summit meeting influence on the decentralisation of TB, engagement of stakeholders to initiate decentralisation, a supportive policy environment for the decentralisation process and guidelines and quarterly clinical expert committee meetings. The factors that influenced the shared motivation for the introduction of MDR-TB decentralisation included actors having a common understanding, limited access to health facilities and emergency transport services, a shared understanding of challenges in providing optimal patient monitoring and review and their appreciation of the value of evidence-based decision-making in the implementation of MDR- TB decentralisation. The capacity for joint action strategies included MoH initiating strategic partnerships in enhancing MDR-TB decentralisation, the role of leadership in organising training of healthcare workers and of multidisciplinary teams, inadequate coordination, supervision and monitoring of laboratory services and joint action in health infrastructural rehabilitation., Conclusions: Principled engagement facilitated the involvement of various stakeholders, the dissemination of relevant policies and guidelines and regular quarterly meetings of clinical expert committees to ensure ongoing support and guidance. A shared motivation among actors was underpinned by a common understanding of the barriers faced while implementing decentralisation efforts. The capacity for joint action was demonstrated through several key strategies, however, challenges such as inadequate coordination, supervision and monitoring of laboratory services, as well as the need for collaborative efforts in health infrastructural rehabilitation were observed. Overall, collaboration has facilitated the creation of a more responsive and comprehensive TB care system, addressing the critical needs of patients and improving health outcomes., (© 2024. The Author(s).)
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- 2024
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123. Exploring the barriers, facilitators, and opportunities to enhance uptake of sexual and reproductive health, HIV and GBV services among adolescent girls and young women in Zambia: a qualitative study.
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Ngoma-Hazemba A, Chavula MP, Sichula N, Silumbwe A, Mweemba O, Mweemba M, Simpungwe MK, Phiri H, Kasengele CT, Halwiindi H, Munakampe MN, and Zulu JM
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- Humans, Zambia, Adolescent, Female, Young Adult, Patient Acceptance of Health Care statistics & numerical data, Patient Acceptance of Health Care psychology, Sexual Health, Interviews as Topic, Qualitative Research, HIV Infections, Reproductive Health Services statistics & numerical data, Health Services Accessibility, Gender-Based Violence statistics & numerical data, Gender-Based Violence psychology
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Introduction: Adolescents and young women in low-middle-income countries face obstacles to accessing HIV, Sexual and Reproductive Health (SRH), and related Gender-Based Violence (GBV) services. This paper presents facilitators, opportunities, and barriers to enhance uptake of HIV, GBV, and SRH services among Adolescent Girls and Young Women (AGYW) in selected districts in Zambia., Methods: This study was conducted in Chongwe, Mazabuka, and Mongu Districts among adolescent girls and young women in Zambia. Key informants (n = 29) and in and out-of-school adolescents and young people (n = 25) were interviewed. Purposive sampling was used to select and recruit the study participants. Interviews were transcribed verbatim, and a content analysis approach was used for analysis., Results: The facilitators that were used to enhance the uptake of services included having access to health education information on comprehensive adolescent HIV and gender-based violence services. Non-governmental organisations (NGOs) were the main source of this information. The opportunities bordered on the availability of integrated approaches to service delivery and strengthened community and health center linkages with referrals for specialised services. However, the researchers noted some barriers at individual, community, and health system levels. Refusal or delay to seek the services, fear of side effects associated with contraceptives, and long distance to the health facility affected the uptake of services. Social stigma and cultural beliefs also influenced the understanding and use of the available services in the community. Health systems barriers were; inadequate infrastructure, low staffing levels, limited capacity of staff to provide all the services, age and gender of providers, and lack of commodities and specialised services., Conclusion: The researchers acknowledge facilitators and opportunities that enhance the uptake of HIV, GBV, and SRH services. However, failure to address barriers at the individual and health systems level always negatively impacts the uptake of known and effective interventions. They propose that programme managers exploit the identified opportunities to enhance uptake of these services for the young population., (© 2024. The Author(s).)
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- 2024
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124. Being both a grandmother and a health worker: experiences of community-based health workers in addressing adolescents' sexual and reproductive health needs in rural Zambia.
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Mulubwa C, Zulu JM, Hurtig AK, and Goicolea I
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- Humans, Zambia, Adolescent, Female, Male, Grandparents psychology, Rural Population, Sexual Health, Interviews as Topic, Qualitative Research, Reproductive Health, Reproductive Health Services, Adult, Community Health Workers psychology
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Introduction: Community-based health workers (CBHWs) possess great potential to be the missing link between the community and the formal health system for improving adolescents' access to sexual and reproductive health and rights (SRHR) information and services. Yet, their role in addressing adolescents' SRHR within the context of the community-based health system has received very little attention. This paper analyses how CBHWs experience and perceive their role in addressing adolescents' SRHR needs in rural Zambia, including the possible barriers, dilemmas, and opportunities that emerge as CBHWs work with adolescents., Methods: Between July and September 2019, we conducted 14 in-depth interviews with 14 community-based health workers recruited across 14 different communities in the central province of Zambia. The interviews were focused on eliciting their experiences and perceptions of providing sexual and reproductive health services to adolescents. Charmaz's grounded theory approach was used for the analysis., Results: We present the core category "being both a grandmother and a CBHW", which builds upon four categories: being educators about sexual and reproductive health; being service providers and a link to SRHR services; being advocates for adolescents' SRHR; and reporting sexual violence. These categories show that CBHWs adopt a dual role of being part of the community (as a grandmother) and part of the health system (as a professional CBHW), in order to create/maximise opportunities and navigate challenges., Conclusion: Community-based health workers could be key actors providing context-specific comprehensive SRHR information and services that could span all the boundaries in the community-based health system. When addressing adolescents SRHR, playing dual roles of being both a grandmother and a professional CBHW were sometimes complimentary and at other times conflicting. Additional research is required to understand how to improve the role of CBHWs in addressing adolescents and young people's sexual and reproductive health., (© 2024. The Author(s).)
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- 2024
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125. Unlocking policy synergies, challenges and contradictions influencing implementation of the Comprehensive Sexuality Education Framework in Zambia: a policy analysis.
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Chavula MP, Zulu JM, Goicolea I, and Hurtig AK
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- Female, Pregnancy, Adolescent, Child, Humans, Zambia, Policy, Policy Making, Sex Education, Sexual Health
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Background: Comprehensive sexuality education (CSE) has recently become salient, but adolescent sexual reproductive health and rights (ASRHR) challenges are still a global health problem. Studying policies which have implications for CSE implementation is a crucial but neglected issue, especially in low and middle-income countries (LMICs) like Zambia. We analyzed policy synergies, challenges and contradictions influencing implementation of CSE framework in Zambia., Methods: We conducted a document review and qualitative interviews with key stakeholders from Non-Governmental Organizations, as well as health and education ministries at the National and all (10) provincial headquarters. Our methods allowed us to capture valuable insights into the synergies, challenges and contradictions that exist in promoting CSE framework in Zambia., Results: The study highlighted the synergies between policies that create opportunities for implementation of CSE through the policy window for adoption of sexual reproductive health and rights (SRHR) that opened around the 1990s in Zambia, promotion of inclusive development via education, adoption of an integrated approach in dealing with SRHR problems, and criminalization of gender-based violence (GBV). This analysis also identified the policy challenges and contradictions including restricted delivery of education on contraception in schools; defining childhood: dual legal controversies and implications for children, grey zones on the minimum age to access SRHR services; inadequate disability inclusiveness in SRHR legal frameworks; policy silences/contentious topics: LGBTQI + rights, abortion, and grey zones on the minimum age to access SRHR services., Conclusion: While many policies support the implementation of CSE in schools, the existence of policy silences and challenges are among the barriers affecting CSE implementation. Thus, policy reformulation is required to address policy silences and challenges to enhance effective promotion and integration of the CSE framework., (© 2023. BioMed Central Ltd., part of Springer Nature.)
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- 2023
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126. Exploring communication and implementation challenges of the HIV/AIDS policy change to test-and-treat-all in selected public health facilities in Lusaka District, Zambia.
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Simooya C, Silumbwe A, Halwindi H, Zulu JM, and Nzala S
- Abstract
Background: The World Health Organization has promoted a shift towards the test-and-treat-all strategy to accelerate the elimination of HIV/AIDS. Zambia was one of the early African countries to adopt this strategy as the policy change was officially announced on national television by the republican president on 15th August 2017. This study explored the communication and implementation challenges of the HIV/AIDS policy change to test-and-treat-all in selected public health facilities in Lusaka District, Zambia., Methods: A qualitative case study design was employed with a purposeful sample of policy makers, international partners, National AIDS Council representatives, health facility managers, and frontline health providers in selected tertiary, secondary and primary health facilities in the Lusaka District, Zambia. Thematic data analysis was performed using NVivo 12 Pro software., Results: In total, 22 key informant interviews and 3 focus group discussions were conducted. The government relied on formal and informal channels to communicate the test-and-treat-all policy change to health providers. Whilst HIV policy changes were reflected in the National HIV/AIDS Strategic Framework, there was little awareness of this policy by the frontline providers. The use of informal communication channels such as verbal and text instructions affected health providers' implementation of the test-and-treat-all. Electronic and print media were ineffective in communicating the test-and-treat-all policy change to some sections of the public. Top-down stakeholder engagement, limited health worker training, and poor financing negatively affected the implementation of the test-and-treat-all policy change. Acceptability of the test-and-treat-all policy change was shaped by positive provider perceptions of its benefits, limited sense of policy ownership, and resistance by the non-treatment-ready patients. Furthermore, unintended consequences of the test-and-treat-all policy change on human resources for health and facility infrastructure were reported., Conclusion: Effective test-and-treat-all policy change communication is vital for successful policy implementation as it enhances interpretation and adoption among health providers and patients. There is a need to enhance collaboration among policy makers, implementers and the public to develop and apply communication strategies that facilitate the adoption of the test-and-treat-all policy changes to sustain gains in the fight against HIV/AIDS., (© 2023. The Author(s).)
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- 2023
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127. Experiences of teachers and community-based health workers in addressing adolescents' sexual reproductive health and rights problems in rural health systems: a case of the RISE project in Zambia.
- Author
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Chilambe K, Mulubwa C, Zulu JM, and Chavula MP
- Subjects
- Pregnancy, Male, Female, Humans, Adolescent, Reproductive Health education, Zambia, Rural Health, Sexual Behavior psychology, Pregnancy in Adolescence prevention & control, Sexual Health
- Abstract
Background: Adolescents in low-and-middle-income countries like Zambia face a high burden of sexual, reproductive, health and rights problems including coerced sex, teenage pregnancies, and early marriages. The Zambia government through Ministry of Education has integrated comprehensive sexuality education (CSE) in the education and school system to contribute towards addressing Adolescents sexual, reproductive, health and rights (ASRHR) problems. This paper sought to explore teachers and community based health workers (CBHWs)' experiences in addressing ASRHR problems in in rural health systems in Zambia., Methodology: The study was conducted under Research Initiative to Support the Empowerment of Girls (RISE) community randomized trial that aims to measure the effectiveness of economic and community interventions in reducing early marriages, teenage pregnancies, and school dropout in Zambia. We conducted qualitative 21 in-depth interviews with teachers and CBHWs involved in the implementation of CSE in communities. Thematic analysis was used to analyse teachers and CBHWs´ roles, challenges, and opportunities in promoting ASRHR services., Results: The study identified teachers and CBHWs roles, and challenges experienced in promoting ASRHR and suggested strategies to enhance delivery of the intervention. The role of teachers and CBHWs in addressing ASRHR problems included mobilizing and sensitizing the community for meetings, providing SRHR counseling services to both adolescents and guardians, and strengthening referral to SRHR services if needed. The challenges experienced included stigmatization associated with difficult experiences such as sexual abuse and pregnancy, shyness among girls to participate when discussing SRHR in the presence of the boys and myths about contraception. The suggested strategies for addressing the challenges included creating safe spaces for adolescents to discuss SRHR issues and engaging adolescents in coming up with the solution., Conclusion: This study provides significant insight on the important roles that teachers CBHWs can play in addressing adolescents SRHR related problems. Overall, the study emphasizes the need to fully engage adolescents in addressing adolescents SRHR problems., (© 2023. The Author(s).)
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- 2023
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128. Application of community dialogue approach to prevent adolescent pregnancy, early marriage and school dropout in Zambia: a case study.
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Zulu IZ, Zulu JM, Svanemyr J, Michelo C, Mutale W, and Sandøy IF
- Subjects
- Adolescent, Child, Female, Humans, Marriage, Pregnancy, Reproductive Health, Student Dropouts, Zambia, Pregnancy in Adolescence prevention & control
- Abstract
Background: Adolescent pregnancy carries both health and economic risks for the pregnant girl and resulting baby, and it is common in Zambia. Providing alternative methods of preventing early pregnancy than abstinence is regarded as culturally and religiously unacceptable in most parts of the country. The community dialogue approach is being tested to address norms and beliefs around early pregnancy, marriage and school dropout, and is based on Paulo Freire's transformative communication approach. The objective of this paper was to understand parents' perspectives on the application of the community dialogue approach in addressing adolescents' early pregnancy and school dropout in a cluster randomized controlled trial in rural Zambia., Methods/design: This was a case study design. We nested the study in the community dialogue intervention arm of the Research Initiative to Support the Empowerment of Girls trial in Zambia. Dialogue meetings were held and economic support was provided for a period of 27 months from September 2016 until November 2018. We held focus group discussions in November 2018 with guardians/parents in six schools in Chibombo District of Central Province. All the discussions were audio recorded and transcribed verbatim. Thematic analysis was used to analyze the data., Results: The guardians/parents perceived the community dialogue to be a relevant approach for addressing social and cultural norms regarding early pregnancy, marriage and school dropout. It was embraced for its value in initiating individual and collective change. The facilitators' interactive approach and dialogue in the community meetings coupled with the use of films and role plays with the parents, lead to active participation and open discussions about sexual and reproductive health (SRH) topics during the community dialogue meetings. Group interactions and sharing of experiences helped parents clarify their SRH values and subsequently made them feel able to communicate about SRH issues with their children. However, cultural and religious beliefs among the parents regarding some topics, like the use of condoms and contraceptives, complicated the delivery of reproductive health messages from the parents to their children., Conclusion: The study indicated that the community dialogue was appreciated by the parents and helped in addressing cultural barriers to discussing SRH issues between generations., (© 2022. The Author(s).)
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- 2022
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129. Strengthening and expanding the capacity of health worker education in Zambia.
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Michelo C, Zulu JM, Simuyemba M, Andrews B, Katubulushi M, Chi B, Njelesani E, Vwalika B, Bowa K, Maimbolwa M, Chipeta J, Goma F, Nzala S, Banda S, Mudenda J, Ahmed Y, Hachambwa L, Wilson C, Vermund S, and Mulla Y
- Subjects
- Capacity Building, Clinical Competence, Curriculum, Education, Medical organization & administration, Educational Technology, Humans, Motivation, Program Development, Staff Development, Zambia, Faculty, Health Personnel education, Public Health education, Students, Health Occupations
- Abstract
Introduction: Zambia is facing a chronic shortage of health care workers. The paper aimed at understanding how the Medical Education Partnership Initiative (MEPI) program facilitated strengthening and expanding of the national capacity and quality of medical education as well as processes for retaining faculty in Zambia., Methods: Data generated through documentary review, key informant interviews and observations were analyzed using a thematic approach., Results: The MEPI program triggered the development of new postgraduate programs thereby increasing student enrollment. This was achieved by leveraging of existing and new partnerships with other universities and differentiating the old Master in Public Health into specialized curriculum. Furthermore, the MEPI program improved the capacity and quality of training by facilitating installation and integration of new technology such as the eGranary digital library, E-learning methods and clinical skills laboratory into the Schools. This technology enabled easy access to relevant data or information, quicker turn around of experiments and enhanced data recording, display and analysis features for experiments. The program also facilitated transforming of the academic environment into a more conducive work place through strengthening the Staff Development program and support towards research activities. These activities stimulated work motivation and interest in research by faculty. Meanwhile, these processes were inhibited by the inability to upload all courses on to Moodle as well as inadequate operating procedures and feedback mechanisms for the Moodle., Conclusion: Expansion and improvement in training processes for health care workers requires targeted investment within medical institutions and strengthening local and international partnerships.
- Published
- 2017
- Full Text
- View/download PDF
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